CITY OF PHILADELPHIA • DEPARTMENT OF LICENSES AND INSPECTIONS

LICENSE LICENSE LICENSE LICENSE LICENSE APPLICAAPPLICAAPPLICAAPPLICAAPPLICATIONTIONTIONTIONTIONMISCELLANEOUSMISCELLANEOUSMISCELLANEOUSMISCELLANEOUSMISCELLANEOUS

Follow instructions listed on the Instruction Sheet.For further information call (215) 686-2490.

WHEN COMPLETED MAIL TO: DEPARTMENT OF LICENSES AND INSPECTIONS

LICENSE ISSUANCE UNIT • PSCMSB - 1401 JOHN F. KENNEDY BOULEVARDPHILADELPHIA, PA 19102

USE A SINGLE CHECK, OR MONEY ORDER FOR ALL FEES PAYABLE TO “CITY OF PHILADELPHIA”.

FEE REVENUE CODE EXPIRATION DATE LICENSE NUMBER

81-901 (1) (Rev. 2/08) LICAPP16See additions on reverse side

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PLEASE BE SURE TO READ OTHER SIDE AND COMPLETE WHERE NECESSARYPLEASE BE SURE TO READ OTHER SIDE AND COMPLETE WHERE NECESSARYPLEASE BE SURE TO READ OTHER SIDE AND COMPLETE WHERE NECESSARYPLEASE BE SURE TO READ OTHER SIDE AND COMPLETE WHERE NECESSARYPLEASE BE SURE TO READ OTHER SIDE AND COMPLETE WHERE NECESSARY

1. NAME OF OWNER (SEE 13) 2. BUSINESS NAME

3. LOCATION OF LICENSED ACTIVITY (INCLUDE ZIP CODE) ZIP CODE

4. DAYTIME TELEPHONE NUMBER EVENING TELEPHONE NUMBER FAX NUMBER E-MAIL ADDRESS

5. BILLING ADDRESS CITY STATE ZIP CODE

6. PHILADELPHIA BUSINESS TAX NUMBER 7. PHILADELPHIA BUSINESS PRIVILEGE NUMBER 8. FEDERAL TAX ID OR SOCIAL SECURITY NUMBER

9. DESCRIPTION OF ACTIVITY/BUSINESS

10. DESCRIPTION (OTHER)

BUSINESS PRIVILEGE $ 250.00 3702 NONE

DRY CLEANERS 75.00 3503 12/31/

DEALER IN PRECIOUS METALS 45.00 3524 4/30/

FINISHING SHOP 75.00 3316 12/31/

LAUNDRY, SELF SERVICE * ($40 + ______ MACH. @ $4.00 EACH) 3387 6/30/

PAWN BROKER 200.00 3381 12/31/

HANDBILL DISTRIBUTION 30.00 3418 8/31/

WEIGHING AND MEASURING DEVICE RETAIL MOTOR FUEL DISPENSER * ( ______ FUELING POINTS @ $35.00 EACH) 3820 9/30/

VEHICLE TANK METER * ( ________ METERS @ $90.00 EACH) 3821 9/30/

LOAD RACK METER * ( ________ METERS @ $90.00 EACH) 3821 9/30/

SCALE 0—50 LBS. * ( ________ SCALES @ $25.00 EACH) 3822 9/30/

SCALE 51—3,000 LBS. * ( ________ SCALES @ $125.00 EACH) 3823 9/30/

SCALE, OVER 3,000 LBS. * ( ________ SCALES @ 200.00 EACH) 3824 9/30/

SCALE HOPPER/CRANE * ( ________ SCALES @ $250.00 EACH) 3825 9/30/

ELECTRONIC SCANNER 6 OR MORE $ 525.00 3826 9/30/

ELECTRONIC SCANNER 1 TO 5 $ 250.00 3827 9/30/

11. LICENSE TYPE

FEE REVENUE CODE EXPIRATION DATE LICENSE NUMBER

ELECTRONIC NON-FOOD SCANNER 6 OR MORE $160.00 3828 9/30/

ELECTRONIC NON-FOOD SCANNER 1 TO 5 $80.00 3829 9/30/

SPRAY PAINT $50.00 3395 12/31/

ATTACHMENTS (Specify)

81-901 (Reverse of 1) (Rev. 2/08)

I hereby certify that the statements contained herein are true and correct to the best of my knowledge and belief. I under-stand that if I knowingly make any false statement herein I am subject to the possible revocation of any licenses issued asa result of my false application, and such other penalties as may be prescribed by law.

Applicant's Signature _______________________________________________________________________________ Date _________________

LICAPP19

13. OWNER CORPORATION AND PARTNERSHIP (LIST THREE PRINCIPALS OR PARTNERS)

14. ADDITIONAL INFORMATION (ATTACH ANOTHER SHEET IF NECESSARY)

OFFICE USE OOFFICE USE OOFFICE USE OOFFICE USE OOFFICE USE ONLNLNLNLNLYYYYY

APPROVED

REFUSED

PREREQUISITES (LIST THOSE CHECKED DURING PROCESSING)

REMARKS:

REVIEWED BY NUMBER DATE AUDIT

MISCELLANEOUS LICENSE MISCELLANEOUS LICENSE MISCELLANEOUS LICENSE MISCELLANEOUS LICENSE MISCELLANEOUS LICENSE APPLICAAPPLICAAPPLICAAPPLICAAPPLICATIONTIONTIONTIONTION

ZONING

All buildings must be in compliance with Philadelphia zoning laws. This includes change of use in existing buildings.

CERTIFICATE OF OCCUPANCY

New buildings and existing buildings where alterations were made must conform to the Philadelphia Building Code and may require that youobtain a Certificate of Occupancy. This determination is made by the L & I Building Unit at 686-2470 or 686-2473.

LOCATIONS THAT ARE CURRENTLY LICENSED FOR THE SAME USE, NEED NO FURTHER ZONING APPROVAL OR CERTIFICATEOF OCCUPANCY.

Zoning Unit, Municipal Services Building, Public Service Concourse, 1401 John F. Kennedy Boulevard, 686-2435.

HOW TO COMPLETE THIS FORM

1) NAME OF OWNER (LICENSEE) — Fill in the name of person, corporation or partnership to whom the license should be issued.Full names must be used. Initials and a last name cannot be accepted. Also complete section 13.

4) PHONE NUMBER — Fill in the telephone number of the person responsible for or knowledgeable of activity.

6) PHILA. BUSINESS TAX ACCOUNT NUMBER — This is a number assigned by the Philadelphia Revenue Department to identifytax accounts. If you have other licenses from the City the one tax number serves for all. If you have never had a number assigned, leaveblank and please fill out the enclosed Revenue Dept. Application for Philadelphia Business Tax Account Number (83-T-5). Any taxaccount previously opened for you which is unsettled or delinquent, will cause delay and may preclude the issuance of new licenses.

7) PHILA. BUSINESS PRIVILEGE LICENSE NUMBER — Fill in the license number if you already have one. Leave blank, if you areapplying for one as part of this application.

8) FEDERAL TAX IDENTIFICATION NUMBER — For individuals it is the same as your Social Security Number. For other taxable ortax exempt entities, it is a number assigned by the Internal Revenue Service (IRS) for reporting purposes. YOUR FEDERAL TAXIDENTIFICATION NUMBER OR YOUR SOCIAL SECURITY NUMBER MUST BE FILLED IN OR THE APPLICATION CANNOT BEPROCESSED.

10) DESCRIPTION OTHER — This space may be used for other descriptions if required for the license you wish to acquire.

11) LICENSE TYPE — Place an “x” in the box in front of the name of each license applied for and attach all required data.

A) Phila. Business Privilege License (3702)

Required for every person desiring to engage in any business within the City of Philadelphia, whether or not such person maintains aplace of business in the city. This is a one-time license. Fill in the license number if you already have one. (Only one license is neededfor multiple locations or multiple businesses for the same person.)

1) A Philadelphia Business Tax Number required. If you have never had a number assigned, fill out the enclosed RevenueDepartment application requesting a tax number.

B) Dry Cleaners License — (3503)

Required of anyone operating any dry cleaning and dyeing plant.

C) Dealer in Precious Metals — (3524)

Required of anyone who purchases or makes appraisals of precious metals and their alloys for resale to refiners, brokers, or the public.Precious metals are defined as items of gold, silver, platinum, and their alloys, including jewelry but excluding coins and bullion. TheLicensee must notify License & Inspections, in writing, within seventy-two (72) hours of any changes in the information supplied to theDepartment. Zoning and C O check required with each application.

1) Provide the following:a. name, home & business address and telephone number of dealer.b. exact location(s), if other than the business address of the dealer, where transactions in precious metals are to be

conducted.c. former business address of dealer for proceeding three (3) years.d. two photographs approx. 2 inches squared of principal (President, if corporation), or each partner if partnership.

2) Weighing devices requirements:a. all scales must be of a type approved for commercial use in the Commonwealth of Pennsylvania and must be inspected

and sealed by the Bureau of Weights and Measures:b. no weighing device is to be removed from one location to another without notification to the Department of Licenses and

Inspections Bureau of Weights and Measures, 990 Spring Garden Street, 3rd Floor, Philadelphia, PA 19123 -

(215) 685-3719.81-901 (2) (Rev. 2/08)

3) Price Posting — The dealer shall post a conspicuous sign in proximity to the place where weighing is made, quoting the pricesoffered for the various units and fineness of precious metals. Prices shall be posted on a sign at least twelve inches in height and at leasttwelve inches in width, stating clearly and legibly in lettering at least one inch in height, the prices offered for the various units andfineness of precious metals.

4) Records Require — All dealers shall maintain records of each transaction in which they purchase precious metals from thepublic or give a statement f appraisal. Such records shall be retained for a period of two years from the date of the transaction andshall be available at the place of issuance for inspections by Weights and Measures during reasonable working hours. Theserecords shall include:

a. the date of the transaction.b. a description of the precious metal or metals involved in the transaction including:

.1) net weight in terms pounds Troy, ounces Troy, pennyweight (Troy) or kilograms/grams.

.2) fineness in terms “karat” for gold and “sterling” for silver.c. legal name and address of the purchaser or appraiser.d. the seller's name and address.e. the seller's motor vehicle operator's number or social security number, or other comparable identification number.f. the seller's left thumbprint.

D) Finishing Shop License — (3316)Required for any structure where more than one gallon of flammable liquid finish is applied per day by means of spraying, dipping,flow coating or any other method. Not applicable to auto repair shops.

E) Laundry, Self Service — (3387)Required of anyone operating a self service laundry. A yearly license fee for each premises and for each washing machine and for eachdryer on the premises must be paid.

Requirements:

1) In section 10 (Description, other) give physical description of premises where the self-service laundry will be located; numberof washing machines and dryers to be used.

2) Site inspection is required for new license or for change of ownership of a location that is currently licensed.a. Post prominently on the premises the name, address and telephone number of the owner or operator of the laundry.

A public telephone is required to be on the premises in a conspicuous location.b. Any dryer located on the premises for use in connection with such washing machines shall be so constructed that it may

be opened from the inside as well as from the outside.

Prohibitions: No licensee shall:a. operate during hours of 1 AM and 6 AM.b. permit lights outside of the premises to remain lighted after 12 Midnight.

F) Pawn Broker License — [3381]Required of anyone in the business of lending money on the deposit or pledge of personal property, securities or written evidenceof indebtedness; or purchasing personal property with an expressed or implied agreement or understanding to sell it back at asubsequent time at a stipulated price; or lending money upon goods, wares or merchandise pledges, stored or deposited ascollateral security fee. The Police Department will review application annually.

1) Requirements:a. Police investigation.

b. Every pawnbroker shall turn over to the Police Department at the end of each day a copy of every pawn ticket furnishedto any pledges.

2) Prohibitions:a. No pawnbroker shall transact any business on Sunday.

b. No pawnbroker shall accept any pledge or effect any redemption before 8:30 AM or after 5 PM, except that pawnbrokers may accept pledges or effect redemptions until 9 PM on Friday and until 6 PM on Saturday.

3) Penalty:a. The penalty for acting as a pawnbroker without a license is a fine of $300.00 together with imprisonment not ex-

ceeding 90 days if the fine and costs are not paid within 10 days.b. The penalty for violation of above requirements or any other provision of Section 9-603 of the Philadelphia Code,

or any term or condition of a license is, in addition to any other sanctions, a fine not exceeding $50.00 for eachoffense together with imprisonment not exceeding 10 days if the fine and costs are not paid within 10 days.

G) Handbill Distribution

Required of any person or business which distributes or causes commercial handbills to be distributed on its behalf.

1) Requirements:

a. Phila. Business Tax Number

b. Business Privilege License

2) Delivery to premises.

a. No person shall place a handbill on private property unless the handbill has been securely placed:

1) in the door (mail) slot.

2) between storm door and house door.

81-901 (Reverse of 2) (Rev. 2/08)

3) on railing.

4) on door grill.

5) or affixed to the door to door handle by string, rubber band or adhesive.

b. Notwithstanding the foregoing, a handbill package may be placed on the top step or on the porch. If placement on the top step or porch is notfeasible, and if placement pursuant to the preceding subsection 2(A) (1)-(5) is not feasible, then a handbill package may be placed against the maindoor at sidewalk level. For purposes of these regulations, a handbill package shall be multiple handbills secured either by rubber band or string or placedin a bag, and weighing cumulatively at least 2 oz. If bagged, handbills must be completely in bag.

c. The Department of Licenses & Inspections shall maintain a "Handbill Non-Delivery List, identifying all properties requesting non-delivery. TheHandbill Non-Delivery List shall be available for public inspection during normal working hours. It shall be the responsibility of any distributor, distributionbusiness or person distributing handbills to insure that no handbills are delivered to such properties.

H) Weighing & Measuring Device License — [3820 thru 3825]

Required for all persons engaged in the business of operating or maintaining a weighing or measuring device for commercial purposes.

1) State number of metering devices to be used.

2) Retail Motor Fuel Dispensers (3820) — Legislation has verified the Retail Motor Fuel Dispenser License as the number offueling points to be licensed.

a. A fueling point is defined as a location where a single vehicle is fueled at one time.

I) Electronic Scanner — (3826 & 3827)

Required of all retail food stores that use electronic terminal scanners or similar checkout systems.

J) Electronic Non-Food Scanner (3828 & 3829) Required of ALL retail merchantile establishments that use electronic scanners or similarcheckout systems.

Sale of Spray Paint containers and Indelible Markers (3395)

Required of anyone who sells or offer for sale, transfer or offer for transfer any spray paint containers and/or indelible markers.

Please do not mail cash. Cash payments cannot be accepted.

Personal checks, money orders or cashier checks are acceptable.

13) OWNER, CORPORATION AND PARTNERSHIP — Corporate applicants must identify the president, secretary and treasurer. Complete with thename, title, and home address. If one individual serves as multiple or sole officer, so state. If partnership, must obtain a Federal IdentificationNumber for the partnership and include social security number of each partner.

14) ADDITIONAL INFORMATION — This space is provided for any additional data you wish to submit.

81-901 (3) (Rev. 2/08)